Who are the high‑risk individuals who should receive meningococcal conjugate (MenACWY) and/or serogroup B (MenB) vaccination?

High-Risk Individuals for Meningococcal Vaccination

Individuals aged ≥10 years with specific medical conditions or exposures require routine meningococcal conjugate (MenACWY) and serogroup B (MenB) vaccination, including those with complement deficiencies, asplenia, microbiologists with N. meningitidis exposure, and persons at risk during outbreaks. 1, 2

Category A Recommendations (Routine Vaccination Required)

The following groups should receive both MenACWY and MenB vaccines as standard care:

1. Complement Deficiencies 1, 2

• Inherited or chronic deficiencies in C3, C5-C9, properdin, factor D, or factor H
• Persons receiving eculizumab (Soliris), a terminal complement inhibitor
• Rationale: These individuals face up to 10,000-fold increased risk of invasive meningococcal disease (IMD) compared to the general population 3

2. Anatomic or Functional Asplenia 1, 2

• Includes sickle cell disease
• Surgical splenectomy or functional asplenia
• Rationale: 20-30-fold increased IMD risk with 40-70% case fatality rate 2, 3
• Critical timing note: For MenACWY-D (Menactra), must wait ≥4 weeks after completing all pneumococcal conjugate vaccine (PCV) doses to avoid immune interference 1

3. Microbiologists 2

• Only those who routinely work with N. meningitidis isolates
• Particularly those with exposure to aerosolized cultures
• Rationale: Up to 271-fold increased IMD risk reported 3

4. Outbreak-Related Risk 1, 2

• Persons identified by CDC as at increased risk during serogroup B or ACWY outbreaks
• Unvaccinated household or household-like contacts of an IMD index case
• Rationale: 100-200-fold increased risk in the year following contact, highest in first 3 months 3
• Action required: Vaccinate as soon as serogroup is identified, even though chemoprophylaxis is given

5. Travelers (MenACWY only) 2

• Persons traveling to areas with hyperendemic or epidemic meningococcal disease
• Particularly the "meningitis belt" of sub-Saharan Africa

6. First-Year College Students (MenACWY only) 2

• Unvaccinated or inadequately vaccinated first-year students living in residence halls
• Higher risk due to close living quarters

7. Military Recruits (MenACWY only) 2

Vaccination Schedules for High-Risk Groups

MenACWY Schedule 1:

• Ages 2-23 months:
  • MenACWY-D: 2 doses ≥12 weeks apart (starting ≥9 months)
  • MenACWY-CRM: Age-specific dosing (2-4 doses depending on start age)
• Ages ≥2 years: Primary series (1-2 doses depending on vaccine and risk)
• Boosters:
  • If <7 years at vaccination: booster if ≥3 years since last dose
  • If ≥7 years at vaccination: booster if ≥5 years since last dose

MenB Schedule 1, 2:

• Ages ≥10 years:
  • MenB-FHbp (Trumenba): 3-dose series at 0,1-2, and 6 months for high-risk individuals 2
  • MenB-4C (Bexsero): 2-dose series ≥1 month apart 2
• Boosters: Single dose if ≥1 year after primary series completion (≥6 months may be considered during outbreaks) 1

Critical Implementation Pitfalls

Common vaccination gaps identified 4, 5:

• Only 28-36% of high-risk patients receive appropriate meningococcal vaccination
• Properdin-complement deficiency patients show <10% vaccination rates 4
• Patients diagnosed before guideline implementation have significantly lower coverage 4

Key strategies to improve uptake 5:

• Pneumococcal vaccination is a strong predictor of meningococcal vaccine receipt (26-fold increased likelihood for MenACWY) 5
• Well-care visits increase vaccination rates 6-11-fold 5
• Use electronic health record algorithms to identify and catch up high-risk patients 4

Category B Recommendation (Permissive)

Healthy adolescents and young adults aged 16-23 years (preferred ages 16-18 years) may receive MenB vaccination for short-term protection, though routine vaccination is not recommended 2. This is based on individual clinical decision-making considering disease epidemiology and antibody persistence data.

Special Considerations

• HIV infection and hypogammaglobulinemia: 5-10-fold increased IMD risk; vaccination recommended though not specifically highlighted in primary guidelines 3
• Age restrictions: Most vaccines licensed for specific age ranges; use outside these ranges is off-label 1
• Vaccine interchangeability: MenB vaccines (MenB-FHbp and MenB-4C) are not interchangeable; complete series with same product 6